股骨颈动力交叉钉系统和空心钉治疗PauwelsⅢ型股骨颈骨折近期疗效

The short-term efficacy of femoral neck system versus that of cannulated compression screw for Pauwels typeⅢfemoral neck fracture

目的探讨股骨颈动力交叉钉系统(FNS)和空心钉(CCS)治疗PauwelsⅢ型股骨颈骨折的临床疗效。方法回顾性分析2020年1月至2021年6月新疆维吾尔自治区人民医院骨科收治的52例PauwelsⅢ型股骨颈骨折患者的临床资料,根据内固定方式不同分为两组:FNS组(n=26)和CCS组(n=26)。比较两组患者的手术时间、术中出血量、切口大小、X线透视次数、骨折愈合时间,Garden对线指数评定骨折复位质量,术后1年股骨颈短缩程度、颈干角丢失程度、股骨头坏死率和骨折不愈合率,术后1年采用Harris评分评价髋关节功能恢复程度。结果FNS组术中透视次数、骨折愈合时间、术后1年股骨颈短缩程度、颈干角丢失程度、髋关节Harris评分优于CCS组(P<0.05);CCS组术中出血量小于FNS组(P<0.05);术后Garden对线指数、术后1年股骨头坏死率、骨折不愈合率两组间比较差异无统计学意义(P>0.05)。结论FNS治疗PauwelsⅢ型股骨颈骨折临床近期疗效肯定,术中透视次数,术后股骨颈短缩程度、颈干角丢失程度、髋关节Harris评分优于CCS组,可作为PauwelsⅢ型股骨颈骨折的优选方案。

Objective To explore the clinical efficacy of femoral neck system(FNS)and cannulated compression screw(CCS)in the treatment of Pauwels typeⅢfemoral neck fracture.Methods The clinical data on 52 patients with Pauwels typeⅢfemoral neck fracture admitted to the Department of Orthopedics and Trauma of the People′s Hospital of Xinjiang Uygur Autonomous Region from January 2020 to June 2021 were retrospectively analyzed.According to different internal fixation modes,they were divided into two groups:FNS group(26 patients),CCS group(26 patients).The surgical duration,intraoperative blood loss,incision size,figure of X-ray fluoroscopy,and time to fracture healing were compared between the two groups.The quality of fracture reduction was assessed by Garden alignment index.The degrees of femoral neck shortening and neck angle loss and rates of femoral head necrosis and fracture nonunion were followed up one year after the procedures.Harris score was used to evaluate the degree of hip function recovery one year after operation.Results There was no significant difference in preoperative general data between the two groups(P>0.05),which was comparable.The intraoperative figure of fluoroscopy,time to fracture healing,degree of femoral neck shortening,degree of neck angle loss,and Harris score on hip joint one year after surgery were significantly better in FNS group than in CCS group,and intraoperative blood loss in CCS group was less than that in FNS group(P<0.05).There were no significant differences in postoperative Garden alignment index and rates of femoral head necrosis and fracture nonunion between the two groups(P>0.05).Conclusions FNS has a positive short-term clinical efficacy in the treatment of PauwelsⅢtype femoral neck fracture.The figure of intraoperative fluoroscopy,degrees of postoperative femoral neck shortening and neck shaft angle loss,and Harris score on hip joint are better than those in the CCS group,which can be used as a preferred scheme for Pauwels typeⅢfemoral neck fracture.